Topic: Lower Abdominal Pain, Pelvic Pain

Many patients complain of chronic pelvic pain. True pelvic pain is commonly felt deep within the bony pelvis or below in the area known as the perineum. However, it may also be felt in the lower abdomen. Thus pelvic pain and abdominal pain may be confused and need to be distinguished. Reviewed 2009.

Pain, a burning or otherwise uncomfortable sensation in the upper abdomen, nausea, or fullness - all of these are symptoms many patients list when they seek medical advice. While we may think of ulcers, gallstones or perhaps inflammation of the pancreas as the cause, all too often even extensive and sophisticated testing does not show any abnormalities. So, why do all these persons feel pain or any of the other symptoms they report?

Functional gastrointestinal (G) disorders significantly impact health related quality of life. This impact is obvious to anyone who has a disorder, or to any provider who cares for people with these disorders. In light of this finding, several medical organizations suggest that healthcare providers carefully monitor the health related quality of life of their patients in order to help guide treatment decisions. However, some studies indicate that many (but by no means all) providers do a poor job of addressing their patients' concerns, and accurately assessing the impact of functional GI disorder symptoms on their overall health status. Patients, in turn, become dissatisfied with their care. This article aims to help both provider and patient understand health related quality of life and improve patient care.

The placebo effect can enhance therapy, and promote a successful relationship between healer and patient. However, a treatment administered by a healer may also have a bad effect. Any treatment may have a predictable risk, but a nocebo effect denotes worsening beyond the known risk – the adverse effect of a failed therapeutic relationship. This can result in sub-optimal health care. An examination of its causes and ways to avoid it are discussed.

Studies show that surgical rates in IBS patients are increased, even though there is no evidence the procedures are beneficial. Surgery is not a treatment for IBS. Yet IBS patients are exposed to more surgical procedures than the general population: the risk is 2–3 times higher for an IBS patient to have gallbladder surgery, appendectomy or hysterectomy; and 10 times higher for colon surgery. The lack of globally effective treatments and clear explanation of the symptoms in IBS contributes to increased utilization of diagnostic testing and predisposes the IBS patients to unnecessary surgical procedures. This fact sheet provides an overview of surgeries and risks in IBS patients.

The most important interaction between patient and doctor is the medical history. Through listening to the story of the patient’s illness and asking relevant questions, a physician may often make a diagnosis, or at least begin to understand the nature and location of the complaint. A few easy steps can help make this process more efficient leading to prompt, more precise diagnosis and treatment. Revised January 2012.

Experimental and clinical studies highlight the existence of sex-related differences in the perception of and responsiveness to painful stimuli. Sex-related differences in pain processing and responsiveness in general have been documented in experimental studies using animal models, and pain is experienced differently by men and women. Sex-related differences have also emerged in the search for new IBS-specific medications.

The anatomical diseases Crohn’s, peptic ulcer, and esophagitis have functional counterparts with some similar symptoms; irritable bowel syndrome (IBS), dyspepsia, and functional heartburn, but these cannot be identified by x-ray or gastroscopy. Thus, for the diagnosis of these functional disorders doctors must rely entirely upon the patient’s description of his or her symptoms.